Fertility Preservation: Options for Women Who are at Risk for Hereditary Ovarian Cancer
Approximately 5 to 15 percent of ovarian cancers can be attributed to hereditary cancer syndromes, which most commonly include the BRCA1 and BRCA2 genes. Knowing if you have an inherited risk for cancer can be a useful tool in prevention, risk reduction, and fertility preservation.
Role of Genetics
BRCA1 and BRCA2 are genes that produce tumor suppressor proteins. These proteins help repair damaged DNA. When either of these genes is mutated or does not function correctly, DNA damage may not be repaired properly. As a result, cells are more likely to develop additional genetic alterations that can lead to cancer.
Women with a BRCA mutation have an estimated 50-85% lifetime risk of developing breast cancer, an estimated 16-60% lifetime risk of developing ovarian cancer, and are at a higher risk of developing either of these cancers at much younger ages.
Genetics and Fertility
If you are a BRCA carrier, you may face difficult issues regarding your desire to conceive, including:
- If and when to undergo risk-reducing surgery, particularly the removal of the fallopian tubes and ovaries
- Potential risk of a diminished ovarian reserve, which can result in lower egg quality and quantity
- Age, which plays a role in all women’s fertility
- Your desired family size
- The possibility of passing on the BRCA mutation since there is a 50% chance an offspring will be a carrier
If you have just received a diagnosis of or are at an increased risk of ovarian cancer as a BRCA gene carrier, you may consider a procedure in which your fallopian tubes and ovaries are removed. The removal of the ovaries has apparent effects on fertility, but there are ways to still safely build a family in the future. Meeting with a reproductive specialist as early as possible is important so you can discuss the medical implications of your carrier status, risk-reducing options, and information regarding fertility preservation.
Fertility Options for Hereditary Cancer Patients
Prior to undergoing surgery, you may choose to preserve your fertility by freezing your eggs. Eggs are frozen using a process called vitrification which preserves them at their current age. At any point in the future, they can be thawed, fertilized, and implanted to achieve a successful pregnancy even after of the removal of fallopian tubes and ovaries. You may also choose to freeze embryos, or fertilized eggs, prior to having surgery.
Research has demonstrated that infertility treatments are safe in BRCA carriers. If you are not ready to consider egg or embryo freezing but still want to be proactive, a less invasive option is hormone monitoring. Annual monitoring of your ovarian reserve includes a blood test to evaluate your AMH level (Anti-Müllerian hormone) and a transvaginal ultrasound of your ovaries to assess follicle count. Your reproductive specialist will help you evaluate your fertility and decide the right time to freeze your eggs and/or embryos.
Receiving an ovarian cancer diagnosis or being at risk for developing hereditary cancer as a carrier of the BRCA1 or BRCA2 gene can be overwhelming but does not have to be defeating. Staying informed and knowing your options can empower you to take proactive steps to preserve your fertility. To learn more about the BRCA mutation, your carrier status, or to assess your fertility, make an appointment with one of our reproductive specialists.